The new guidelines will be evidence-based and comprehensive, says researchers.

NASHVILLE -- Still more changes are coming to the advice that the American Association of Clinical Endocrinologists gives to clinicians for managing obese patients.

AACE is expected to release new evidence-based guidelines for managing obesity, as well as a "toolkit" for clinicians, in the next few months. The association now relies on a "framework," or algorithm, that clinicians can use to treat the disease, but it isn't evidence-based, said Timothy Garvey, MD, who is chair of the AACE Obesity Scientific Committee and a professor at the University of Alabama at Birmingham.

"We really don't have evidence-based guidelines to base our algorithm upon," he said at a press conference at the annual meeting of AACE on May 13. "The evaluation of evidence will either support, refute, or lead to modification of that algorithm."

The new guidelines will be comprehensive, and will address practical issues of managing obesity. And the upcoming toolkit will give clinicians access to information that can make caring for obese patients easier, said Garvey. Some of the tools are a new algorithm based on evidence, strategies for counseling with patients, suggestions for setting up an office, and an obesity-focused review of systems.

A Changing Outlook

It's been 3 years since AACE declared obesity to be a disease. In the time since then, they've released guidelines for bariatric surgery, guidelines for healthy eating, an obesity management algorithm, and a "position statement" on obesity as a chronic disease.

At last year's annual meeting in Las Vegas, AACE released a new "framework" -- but stopped short of calling them guidelines -- for clinicians to diagnose and manage obesity. The new guidelines moved away from a heavy focus on body mass index (BMI) towards an approach that focuses on obesity-related complications.

There are several different guidelines for treating obesity from different societies and groups -- at least seven of them, by Garvey's count, including from the Endocrine Society, the National Institutes of Health, and NICE, the National Institute for Health and Care Excellence, in the U.K.

"Pharmacological treatment should be considered only after dietary, exercise, and behavioral approaches have been started and evaluated," reads one guideline that NICE adheres to. "Consider drug treatment for people who have not reached their target weight loss or have reached a plateau on dietary, activity, and behavioural changes."

But "just because these guidelines say they're evidence-based doesn't mean they're evidence-based," said Garver -- NICE's guidelines aren't necessarily based on the best available evidence.

"We don't think any of these, including ours for that matter, is entirely sufficient for practical applications by professionals," added Garver. "For one thing, they're not comprehensive."

Another question the future guidelines must incorporate is when and how obesity medications should be prescribed. Several drugs are now on the market after years-long efforts of trying to get the FDA's approval. But little long-term data are available on cardiovascular and other outcomes.

So far, the changes in approaches to obesity have been gradual, Garvey told MedPage Today. "In terms of providers, I think we are making a difference, but it's slow," he said. But the groups that have given the most positive feedback from the changes are large employers, benefit providers, and insurers, according to Garvey.

"What our approach does is target those individuals that would most benefit from weight loss," he said. "That seems to resonate with them."

Garvey said he hopes that the guidelines and toolkit -- along with a white paper on obesity -- will be ready to publish by fall of this year. In addition, a second consensus conference on obesity is being planned.

The first conference, held with the American College of Endocrinology in Washington, D.C., more than a year ago, attempted to come up with a better definition of obesity and a framework to address it. The upcoming conference will be aimed at "harmonizing the guidelines" that are used by several different societies, Garvey said.

Some of the guidelines don't address obesity medications, and all of them are incomplete, Garvey said. He added that as a result of the conference, he hopes AACE will be able to come up with guidelines that cover all aspects of managing obesity.

Toolkit

Felice Caldarella, MD, at the Center for Advanced Weight Loss, said that the upcoming toolkit will make it easier for physicians to know how to best treat their patients with obesity. In a session here, he said that clinicians need to get their patients motivated, which means knowing how to talk about obesity with them.

"We really need to be aware of the words we use," he said. "Patients who are told to lose weight every time they visit will quickly lose interest." The toolkit provides strategies for interviewing patients.

Caldarella shared a story about a heavily obese patient who was trying to get on the examination table but lost his footing on a small stool. His doctor tried to catch him, and both ended up getting injured. The toolkit will include information to help doctors prevent situations like this by setting up the office to better serve obese patients.

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